Provider Demographics
NPI:1285470922
Name:DIMINICK, CHAD (DDS)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:DIMINICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 BLUFF CITY HWY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4610
Mailing Address - Country:US
Mailing Address - Phone:423-968-2172
Mailing Address - Fax:423-968-1987
Practice Address - Street 1:744 BLUFF CITY HWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4610
Practice Address - Country:US
Practice Address - Phone:423-968-2172
Practice Address - Fax:423-968-1987
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist